Internal Medicine-pediatrics Research Articles

A shared point of care ultrasound curriculum for graduate medical education

BackgroundPoint of care ultrasound (POCUS) education has grown significantly over the past two decades. Like most curricular items, POCUS education is siloed within individual graduate medical education (GME) programs. The purpose of this study was to evaluate the effectiveness of a shared GME POCUS curriculum between five GME programs at a single institution.MethodsPost-graduate-year-1 (PGY-1) residents from emergency medicine (EM), family medicine (FM), internal medicine (IM), combined internal medicine-pediatrics (IM-Peds) and combined emergency medicine-pediatrics (EM-Peds) residency programs were enrolled in a core POCUS curriculum. The curriculum included eleven asynchronous online learning modules and ten hands-on training sessions proctored by sonographers and faculty physicians with POCUS expertise. Data was gathered about the curriculum’s effectiveness including participation, pre- and post-curricular surveys, pre- and post-knowledge assessments, and an objective skills assessment.ResultsOf the 85 residents enrolled, 61 (72%) participated in the curriculum. Engagement varied between programs, with attendance at hands-on sessions varying the most (EM 100%, EM-Peds 100%, FM 40%, IM 22%, Med-Peds 11%). Pre- and post-knowledge assessment scores improved for all components of the curriculum. Participants felt significantly more confident with image acquisition, anatomy recognition, interpreting images and incorporating POCUS findings into clinical practice (p < 0.001) after completing the curriculum.ConclusionIn this shared GME POCUS curriculum, we found significant improvement in POCUS knowledge, attitudes, and psychomotor skills. This shared approach may be a viable way for other institutions to provide POCUS education broadly to their GME programs.

Opportunities in Pulmonary and Critical Care Medicine for Dual-trained Medicine and Pediatric Physicians.

Combined internal medicine-pediatrics (med-peds) training has been recognized as a unique, Accreditation Council for Graduate Medical Education-accredited residency pathway since 1967, resulting in more than 10,000 graduates. Med-peds graduates have the option of pursuing combined med-peds fellowships with a 1-year reduction in training time compared with pursuing such fellowships separately. The typical med-peds resident spends 8-9 months in the intensive care unit during residency, with additional rotations in pulmonary medicine; not surprisingly, residents are increasingly inquiring about combined med-peds fellowship training within the fields of pulmonary and critical care medicine. In this review, we outline both the advantages and challenges of such training and present various pathways and considerations to achieve board certification.

Internal Medicine and Internal Medicine-Pediatrics Residency Program Website Traffic Patterns Across Two Institutions and Five Electronic Residency Application Service (ERAS) Cycles.

Background Since the start of the COVID-19 pandemic in Spring 2020, medical residency program recruitment has become increasingly web-based due to the transition to virtual interviews. Although social media use by residency programs has soared during this time, applicant surveys show that official program websites remain the most used online resource. According to survey-based studies, the content that applicants favor on program websites tends to mirror their priorities in choosing programs. However, it is unclear whether applicant-reported priorities in program choice and website content truly drive program website traffic. In this analysis, we will elucidate website traffic patterns from two Internal Medicine residency programs and two Internal Medicine-Pediatrics programs, both in terms of the thematic content of high-traffic pages and changes in traffic patterns throughout the Electronic Residency Application Service (ERAS) application cycle. We will provide novel, data-driven guidance to residency program leadership regarding website content. Methodology For each of the four programs included in the analysis, total pageviews on a monthly basis were obtained for the annual ERAS application cycles taking place from 2017 through 2022. For one Internal Medicine program, data was only available for its current website from 2020 to 2022. The mean monthly pageviews were calculated for each page within each website. The total site traffic trends across each year and within high-traffic months were totaled as well. Results As expected, the highest traffic period for all programs in all years was the days before the application deadline, with a secondary, smaller spike in traffic around Match Day. In general, the most popular pages for all four programs were thematically in line with the top five applicant priorities in the 2022 National Resident Matching Program applicant survey, namely, geographic location, goodness of fit, program reputation, work/life balance, and current program residents. Three of the websites featured unique content that unexpectedly proved to be as popular as the top survey-reported topics, such as pages related to a new major clinical site, a new integrated subspecialty pathway, and, most profoundly, a pipeline program for certain applicants from groups that are underrepresented in medicine. Alumni career content was also heavily trafficked across all four programs. Conclusions Program directors should plan twice-yearly updates to residency program websites, timed to be finished by the start of the ERAS cycle in the fall, and again just before Match Day in March. Program directors should include specific, up-to-date information about unique program features. Future research should incorporate a more diverse variety of programs, software-based page content analysis, and traffic source data.

A Quality Improvement Initiative to Improve Health Care Transition Planning at Adolescent Well Visits

ObjectiveHealth care transition (HCT) planning supports adolescents as they move from pediatric to adult health care and is recommended for all youth. HCT planning uptake remains low, with little known about HCT in the adolescent well child check (WCC) setting. We sought to increase rates of HCT planning at WCCs by adapting best practices for HCT from specialty and chronic care. MethodsThis quality improvement initiative at 12 to 17-year-old WCCs at four Internal Medicine-Pediatrics primary care clinics, was based on the first three of the “Six Core Elements” of HCT framework and integrated into the electronic health record. Two uptake measures were assessed via chart review after three plan-do-study-act (PDSA) cycles, with two provider surveys and an implementation science analysis further informing interpretation. ResultsBy the final PDSA cycle, the percentage of 14 to 17-year-old WCCs at which HCT planning was discussed and a screening tool completed increased from 5% to 31%, and the percentage of 12 to 13-year-old WCCs at which the HCT policy was discussed increased from 6% to 47%. Provider survey results revealed endorsement of HCT goals, but time and technological barriers, which were further elucidated in the implementation science analysis. ConclusionsThis quality improvement initiative increased rates of HCT planning during adolescent WCCs. While limited to three Core Elements and Internal Medicine-Pediatrics clinics, strengths include measures capturing all WCCs, contextualized by provider surveys and an implementation science framework. Lessons from this effort can inform future tailored HCT initiatives at adolescent WCCs.

Perceptions of X+Y Scheduling Among Combined Internal Medicine-Pediatrics Residency Trainees: A Qualitative Program Evaluation.

The study aims to elicit perceived benefits and downsides of X+Y scheduling for combined Internal Medicine-Pediatrics (Med-Peds) residents via focus groups. Five focus groups were conducted with Med-Peds residents in participating programs which utilized X+Y scheduling. Onefocus group was held per participating institution. Each focus group was facilitated by a chief resident from a different participating institution. Questions were developed by the study team after a review of the literature and local experience with X+Y scheduling and included open-ended questions. Focus groups were recorded and transcribed. Transcripts were reviewed by study team members, and representative themes and quotes were presented. The main outcome was to evaluate the perceived benefits and downsides of X+Y scheduling for Med-Peds. Results from four of the five focus groups were fully reviewed. Themes regarding the benefits of X+Y scheduling included (1) improved inpatient and outpatient experience, (2) predictability in schedule which improved wellness, and (3) longitudinal time for career exploration. Downsides of X+Y scheduling were highlighted as well including(1) condensing too many experiences into Y time and (2) challenges that exist when categorical medicine and pediatrics programs use different block schedules. X+Y schedules create potential solutions for longstanding barriers to medical education and notably conflict with inpatient and outpatient responsibilities. Our data shows similar benefits to X+Y scheduling for combined residents as for their categorical colleagues and sheds light on some unique considerations for combined programs and trainees. Additional studies should continue to assess the effect of X+Y scheduling on our combined trainees.

Using Natural Language Processing to Identify Key Values in Internal Medicine-Pediatrics Residency Applications.

Using Natural Language Processing to Identify Key Values in Internal Medicine-Pediatrics Residency Applications.

The Resident Readiness Survey: A National Process for Program Directors to Provide Standardized Feedback to Medical Schools About Their Graduates.

Background The process for program directors (PDs) to provide feedback to medical schools about their graduates' readiness for postgraduate year 1 (PGY-1) training is burdensome and does not generate national benchmarking data. Objective The Association of American Medical Colleges (AAMC) tested the feasibility of administering a standardized Resident Readiness Survey (RRS) to PDs nationally about their PGY-1 residents' preparedness for residency. Methods In 2020 and 2021, the AAMC invited PDs via email to complete RRSs for their PGY-1s who graduated from participating schools; the AAMC provided schools with reports of identified RRS data for their graduates. Outcome measures included school participation rates, PD response rates, PGY-1s' coverage rates (RRSs completed/RRSs PDs invited to complete), RRS completion time (time-stamp difference: RRS opening-submission), and participating schools' feedback about the process collected via AAMC evaluation questionnaires sent to school leaders. Chi-square tested significance of differences between proportions. Results School participation increased from 43.8% (2020: 77 of 176) to 72.4% (2021: 131 of 181). PD response rates, similar in both years overall (2020: 1786 of 2847 [62.7%]; 2021: 2107 of 3406 [61.9%]; P=.48), varied by specialty (P<.001; range 65 of 154 [42.2%], neurology; 109 of 136 [80.1%], internal medicine-pediatrics, both years combined). PGY-1s' coverage rates were similar (P=.21) in 2020 (5567 of 10 712 [52.0%]) and 2021 (9688 of 18 372 [52.7%]). RRS completion time averaged less than 3 minutes. Numerous school leaders reported that RRS data stimulated new, or supported ongoing, curricular quality improvement. Conclusions Administration of a standardized RRS to PDs nationally about PGY-1s preparedness for residency is feasible and will continue.

Using Natural Language Processing and Machine Learning to Identify Internal Medicine-Pediatrics Residency Values in Applications.

Although holistic review has been used successfully in some residency programs to decrease bias, such review is time-consuming and unsustainable for many programs without initial prescreening. The unstructured qualitative data in residency applications, including notable experiences, letters of recommendation, personal statement, and medical student performance evaluations, require extensive time, resources, and metrics to evaluate; therefore, previous applicant screening relied heavily on quantitative metrics, which can be socioeconomically and racially biased. Using residency applications to the University of Utah internal medicine-pediatrics program from 2015 to 2019, the authors extracted relevant snippets of text from the narrative sections of applications. Expert reviewers annotated these snippets into specific values (academic strength; intellectual curiosity; compassion; communication; work ethic; teamwork; leadership; self-awareness; diversity, equity, and inclusion; professionalism; and adaptability) previously identified as associated with resident success. The authors prospectively applied a machine learning model (MLM) to snippets from applications from 2023, and output was compared with a manual holistic review performed without knowledge of MLM results. Overall, the MLM had a sensitivity of 0.64, specificity of 0.97, positive predictive value of 0.62, negative predictive value of 0.97, and F1 score of 0.63. The mean (SD) total number of annotations per application was significantly correlated with invited for interview status (invited: 208.6 [59.1]; not invited: 145.2 [57.2]; P < .001). In addition, 8 of the 10 individual values were significantly predictive of an applicant's invited for interview status. The authors created an MLM that can identify several values important for resident success in internal medicine-pediatrics programs with moderate sensitivity and high specificity. The authors will continue to refine the MLM by increasing the number of annotations, exploring parameter tuning and feature engineering options, and identifying which application sections have the highest correlation with invited for interview status.

The Role of Internal Medicine-Pediatric Programs and Transition Champions in Graduate Medical Trainee Health Care Transition Development

ObjectiveTransition to adult health care for adolescents and young adults (AYAs), especially those with chronic conditions, is a critical time. Medical trainees lack competency in providing transition care, but little is known about the factors contributing to the development of health care transition (HCT) knowledge, attitudes, and practice. This study examines how Internal Medicine-Pediatrics (Med-Peds) programs and institutional HCT champions influence trainee HCT knowledge, attitudes, and practices. Study DesignA 78-item electronic survey regarding the knowledge, attitudes, and practices of caring for AYA patients was sent to trainees from 11 graduate medical institutions. ResultsA total of 149 responses were analyzed, including 83 from institutions with Med-Peds programs and 63 from institutions without Med-Peds programs. Trainees with an institutional Med-Peds Program were more likely to identify an institutional HCT champion (odds ratio, 10.67; 95% confidence interval, 2.40–47.44; p = .002). The mean HCT knowledge scores and use of a routine, standardized HCT tools were higher in trainees with an institutional HCT champion. Trainees without an institutional Med-Peds program experienced more barriers to HCT education. Trainees with institutional HCT champions or Med-Peds programs reported greater comfort in providing transition education and using validated, standardized transition tools. DiscussionThe presence of a Med-Peds residency program was associated with a greater likelihood of a visible institutional HCT champion. Both factors were associated with increased HCT knowledge, positive attitudes, and HCT practices. Both clinical champions and adoption of Med-Peds program curricula will enhance HCT training within graduate medical education.

A half‐century check‐up for child neurology training

A half‐century check‐up for child neurology training

1296. Customized Learning About Bettering Sterile Insertion (CLABSI): A Look at Reducing Hospital Acquired Line Infections

Abstract Background Central line associated bloodstream infections (CLABSIs) are associated with significant clinical and economic impacts. A large portion of central venous lines (CVLs) placed at the University of Arkansas for Medical Sciences are done so by resident physicians. A formal education session focusing specifically on aseptic technique for residents has not been utilized so far. Methods Literature review and expert opinion was used to guide development of a multi-modal resident education session. The session consisted of a PowerPoint presentation, a video tutorial, and a CVL insertion checklist. More than 50% of the time was allotted to a hands-on session led by residents demonstrating how to aseptically place a CVL under the supervision of an Infection Preventionist. A Likert scale was utilized to assess the level of confidence residents had regarding eight CLABSI prevention metrics both before and after attending the session. Additionally, residents were polled to assess their preferred teaching modality. 66 internal medicine residents and 18 internal medicine-pediatrics residents participated in the study over a five-week period. The results were assessed for statistical significance with a two-tailed Mann-Whitney U-test. Results Responses were received from 54 residents prior to the simulation lab session, and from 56 residents after the simulation lab session. The total resident response rate was 66.67%. A statistically significant improvement in resident confidence was found in all eight surveyed CLABSI prevention metrics. The majority of responding residents found workshop style sessions, peer-to-peer teaching and educational videos to be the most useful modalities to deliver information. Bar Graph Demonstrating a Side by Side Comparison of Resident Reponses Pre- and Post-Intervention Bar Graph Demonstrating a Side by Side Comparison of Resident Reponses Pre- and Post-Intervention Resident Responses to Preferred Methods of Learning about CLABSI's Pre- and Post-Intervention Conclusion Attendance of a two-hour multimodal resident-driven educational session improved the confidence of residents in their knowledge and implementation of CLABSI prevention metrics. Participants preferred learning via workshop style sessions and educational videos. We recommend a multi-modal approach to resident education, and the consistent involvement of an Infection Preventionist. We hope to expand our curriculum to involve residents in other departments and explore the variation in preferred learning modalities and its overall impact on hospital CLABSI rates Disclosures Hazel K. Liverett, MD, Merck: Stocks/Bonds.

PEDIATRIC AND MEDICINE RESIDENTS’ PERCEPTIONS OF ULTRASOUND VASCULAR ACCESS AND RESULTS OF AN INTERSPECIALTY, SIMULATION-BASED ULTRASOUND VASCULAR ACCESS WORKSHOP

PEDIATRIC AND MEDICINE RESIDENTS’ PERCEPTIONS OF ULTRASOUND VASCULAR ACCESS AND RESULTS OF AN INTERSPECIALTY, SIMULATION-BASED ULTRASOUND VASCULAR ACCESS WORKSHOP

S1561 Food Is Medicine: A Novel Educational Intervention to Improve Nutritional Competency in Graduate Medical Education

Introduction: Nutrition plays a critical role in the pathogenesis of many chronic conditions, and thus it is essential that physicians and trainees possess a strong knowledge base of key nutritional concepts. This is especially relevant to gastroenterologists, who care for patients at high risk for developing nutritional abnormalities due to complications of their gastrointestinal diseases. However, physicians receive minimal nutritional instruction throughout their medical training due to curricular and time constraints and often feel unprepared to effectively counsel patients on key aspects of nutrition. This study aimed to evaluate resident physicians’ attitudes toward nutrition and to improve competency in nutritional counseling using a novel educational intervention. Methods: We implemented a novel nutrition training intervention, aimed at senior internal medicine and internal medicine-pediatrics residents. A scripted presentation was developed on fundamental nutritional concepts and evidence-based nutritional considerations on topics deemed highest priority by the American Society for Clinical Nutrition Committee on Medical/Dental School and Residency Nutrition Education. Resident physicians were surveyed using an abbreviated version of a validated nutrition survey and questionnaire evaluating attitudes on nutrition and objective nutritional competence before and after receiving the presentation. Comparison of pre- and post-intervention scores was made by 2-sample t-test. Results: Among the 39 resident physicians who completed the survey, 85% believed physicians are not adequately trained to counsel patients on nutrition, and 95% expressed the desire to improve their competency in nutrition. Mean scores of objective nutritional competence were significantly improved after administration of the nutritional intervention (63.6% ±11.8 vs 72.2% ±11.5; P=0.017, CI -3.29 to -0.34), as was subjective confidence in counseling patients on all surveyed nutritional concepts (Table). Conclusion: Our study suggests that resident physicians value nutritional education and desire to improve their knowledge of nutrition, but the majority are not satisfied with the current quality of nutrition training. Our novel educational intervention is a simple, efficient method of improving objective nutritional competency among resident physicians that can be easily implemented while respecting time constraints associated with graduate medical training. Table 1. - Basic participant demographics as well as observed measures of subjective confidence and objective competence in nutritional counseling Baseline Participant Demographics Pre-Intervention Survey Completion Post-intervention Survey Completion PGY2 22 12 PGY3 14 4 PGY4 2 1 Male 29 12 Female 10 6 Objective Competence Scores Pre-Intervention (n=39) Post-intervention (n=18) P-Value 63.60% 72.20% 0.0169 Measurement of Subjective Confidence in Nutritional Counseling Nutritional Topic Pre-Intervention (n=39) Post-Intervention (n=18) P-Value Food constituents 2.85 4.12 < 0.0001 Body mass index 3.08 4.06 0.0055 Basic metabolism 3.46 4.67 0.0007 Vitamins 3.00 4.17 0.0003 Omega-3/6 fats 3.11 3.72 0.0409 Dietary cholesterol 3.55 4.28 0.0103 Type 2 diabetes 3.90 4.50 0.0033 Osteoporosis 3.26 4.00 0.0032 HIV 2.08 3.89 < 0.0001 Objective competence was determined utilizing 22 questions from a validated nutrition assessment survey, and scores are reflected as percentage correct. Subjective confidence was determined using a validated questionnaire assessing comfort level and knowledge of nutritional interventions in commonly-encountered diseases in primary care, and was scored on a scale of 1-5 from least to most comforTable, respectively. HIV - human immunodeficiency virus. PGY – post-graduate year.

First Author Spotlight

AnnouncementFirst Author SpotlightPublished Online:09 Sep 2022https://doi.org/10.1152/ajprenal.2022.323.3.AUMoreSectionsPDF (285 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat RAWAN ALMUTLAQCardiorenal Physiology and Medicine, Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AlabamaFigure 1.Rawan AlmutlaqDownload figureDownload PowerPointRawan Almutlaq is a PhD student in the Department of Integrative Biology and Physiology at the University of Minnesota, mentored by Dr. Louise Evans. She earned her BS in Biochemistry from King Abdulaziz University and her MS in Biotechnology from the University of Alabama at Birmingham. Her research interest focuses on salt-sensitive hypertension. In her spare time, she likes to bake [Photo: Fig. 1].https://doi.org/10.1152/ajprenal.00055.2022DENISE C. HASSONDivision of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OhioFigure 2.Denise HassonDownload figureDownload PowerPointDenise Hasson was born and raised in a suburb of Los Angeles, CA. She graduated from Dartmouth College and then earned her medical degree at Keck School of Medicine at the University of Southern California. She completed an Internal Medicine-Pediatrics Residency at the University of Colorado Hospital/Children's Hospital Colorado. She moved to Cincinnati, OH, to pursue research mentorship from Dr. Steve Standage, Dr. Hector Wong, and Dr. Stuart Goldstein in the laboratory of Dr. Steve Standage at Cincinnati Children's Hospital Medical Center. She finished a Pediatrics Critical Care Fellowship and a Critical Care Nephrology Fellowship. Her research interests focus on the improvement of pediatric acute kidney injury outcomes with a translational approach to nutritional/metabolic optimization. She has accepted a position as a Clinical Assistant Professor in the Department of Pediatrics at NYU Langone Health/NYU Grossman School of Medicine. Denise enjoys traveling, biking, swimming, and she is a loyal Dodgers fan [Photo: Fig. 2].https://doi.org/10.1152/ajprenal.00033.2022SOPHIA M. SEARSDepartment of Pharmacology and Toxicology, University of Louisville, Louisville, KentuckyFigure 3.Sophia SearsDownload figureDownload PowerPointSophia Sears recently earned her PhD in Pharmacology and Toxicology from the University of Louisville. During her graduate studies, she was awarded an F31 predoctoral fellowship from the National Institute of Diabetes and Digestive and Kidney Diseases under the mentorship of Dr. Leah Siskind. She then became a postdoctoral associate in Dr. Siskind's laboratory. Her research interests include chronic kidney disease and inflammation. In her spare time, she enjoys exercising and playing with her dog [Photo: Fig. 3].https://doi.org/10.1152/ajprenal.00097.2022This article has no references to display. Download PDF Back to Top Next FiguresReferencesRelatedInformationRelated ArticlesAromatase inhibition increases blood pressure and markers of renal injury in female rats 23 Aug 2022American Journal of Physiology-Renal PhysiologyCholine supplementation attenuates experimental sepsis-associated acute kidney injury 17 Aug 2022American Journal of Physiology-Renal PhysiologyPharmacological inhibitors of autophagy have opposite effects in acute and chronic cisplatin-induced kidney injury 17 Aug 2022American Journal of Physiology-Renal Physiology More from this issue > Volume 323Issue 3September 2022Pages i-i Crossmark Copyright & PermissionsCopyright © 2022 the American Physiological Society.https://doi.org/10.1152/ajprenal.2022.323.3.AUHistory Published online 9 September 2022 Published in print 1 September 2022 Metrics

Redesigning Care of Hospitalized Young Adults With Chronic Childhood-Onset Disease.

BackgroundYoung adults with chronic childhood-onset disease (CCOD) are routinely admitted to internal medicine hospitalist services, yet most lack transition preparation to adult care. Providers and patients feel the strain of admissions to adult services in part due to their medical and social complexity.MethodsWe performed a descriptive study of a care redesign project for young adults with CCOD hospitalized at a large, tertiary care academic hospital. We describe the process of implementation of the Med-Peds (MP) service line and characterize patients cared for by the service. We measured and analyzed patient demographics, process implementation, healthcare screening, and healthcare utilization data.ResultsDuring the 16 months of the study period, 254 patients were cared for by the MP service line, accounting for 385 hospitalizations. The most common CCODs were sickle cell disease (22.4%) and type 1 diabetes (14.6%). The majority (76%) of patients completed transition readiness assessment, and 38.6% completed social determinant of health (SDH) screening during their admission. Patients had high prevalence of SDH with 66.7% having an unmet social need. The average length of stay was 6.6 days and the average 30-day readmission rate was 20.0%.ConclusionsThere is opportunity to redesign the inpatient care of young adult patients with CCOD. The MP service line is a care model that can be integrated into existing hospital medicine teams with MP physicians. Hospitals should consider redesigning care for young adults with CCOD to meet the transitional and social needs unique to this patient population.

The Case for Medicine-Pediatrics Training in the U.S. Military.

Residency programs in the combined specialty of Internal Medicine-Pediatrics (Med-Peds) are not offered in the military graduate medical education system despite existing in the civilian sector for over 50 years. This residency consists of 4 years of training and results in the development of board-certified internists and pediatricians who can care for patients from infancy to death. This versatility, combined with an emphasis on the transition from childhood to adulthood, would be valuable to the Military Health System. Med-Peds physicians could serve in a variety of settings depending on the needs of the military: in the outpatient clinic, in the hospital, or in an operational setting. Specifically, Med-Peds doctors could operate as critical care extenders in austere or operational environments to patients of all ages. This could improve outcomes of pediatric casualties in war because of specific training in both medical and pediatric intensive care units. Med-Peds physicians would integrate seamlessly into the Military Health System to work alongside family medicine doctors, internists, and pediatricians to provide high-quality primary care to service members; this may also allow for the increased flexibility of the medical corps. As there are already military residency programs in pediatrics and internal medicine, the required infrastructure for such a training program exists. The addition of this residency may also lead to more interest in military medicine from prospective applicants to medical school. This essay uses personal experience to explain how the addition of this specialty to the military would benefit the medical mission domestically and abroad.

An Expanded Primary Care-Based Women's Health Clinic to Improve Resident Education and Patient Care in Resident Continuity Clinic.

Internal medicine (IM) residents are underprepared in women's health. Lack of properly trained faculty and clinic culture limits the ability to provide bedside teaching. Assess the impact of a primary care-based, women's clinic on residents' quality of care for females. Large academic, urban primary care clinic with resident and faculty practices PARTICIPANTS: PGY-2 IM and Med-Peds (MP) residents PROGRAM DESCRIPTION: A weekly half-day, women's clinic to provide expanded women's healthcare to primary care group patients. Residents rotate through the clinic to receive bedside teaching. Chart review was performed for a representative sample of reproductive-aged women seen in primary care before and after the establishment of the women's clinic. A total of 666 charts were reviewed (314 pre, 352 post). Improvement was seen in residents' rate of sexual histories (54% vs 75%, p< 0.01) with a significant decrease in women not asked about contraception (15% vs 3%, p<0.01). Overall there was a decrease in gynecology referrals (18 to 11%, p=0.02). After implementing the women's health clinic, more women were asked about sexual health needs, and fewer were referred to gynecology, suggesting increased women's healthcare provided by residents.

Thriving in Residency: a Qualitative Study.

BackgroundWhile a great deal of research has brought attention to the issue of physician burnout in recent years, and resident physician burnout in particular, the topics of physician well-being, and by extension physician thriving, have been relatively understudied. Consequently, we propose a model of resident physician thriving.ObjectiveTo understand what factors contribute to a subjective sense of thriving among resident physicians.DesignIn this study, we conducted in-depth interviews from May 2020 through February 2021 with resident physicians to determine what factors have contributed to their sense of thriving in their careers as well as in their lives more generally. We used a snowball sampling technique to recruit participants. Validated instruments were used to quantify the participant’s subjective level of job and life satisfaction as well as their level of career burnout. To derive our conclusions, we employed thematic content analysis using a grounded theory-based approach.ParticipantsResident physicians in the internal medicine, pediatrics, and combined internal medicine-pediatrics residency programs at a single university-affiliated institution.ApproachWe interviewed those residents with high life, career, and residency satisfaction who did not meet criteria for burnout to explore those factors that contribute to their sense of thriving.Key ResultsThirty-seven screening interviews were conducted. Twenty-four participants met criteria for life, career, and residency satisfaction while also not meeting criteria for burnout. The six key themes contributing to resident thriving that we identified during the course of our analysis included program leadership, learning climate, connectedness, joy in medicine, life balance, and intrinsic factors.ConclusionsThis project proposes a model of resident thriving that can potentially inform program structure, culture, and values.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07504-6.

Med-Peds Residents’ Career Plans and the Impact of Pediatric Hospital Medicine Fellowship: A Nationwide Survey

Background The establishment of pediatric hospital medicine (PHM) as a fellowship-trained subspecialty represents a major change in the practice landscape, particularly for combined internal medicine-pediatrics (med-peds) residents. The most recent literature on med-peds residents’ career choices predates PHM fellowship and its impact has not been well studied. We aimed characterize med-peds residents’ career plans and the factors influencing their choices. Methods We distributed an electronic survey to the 1,505 resident members of the National Med-Peds Resident Association. In addition to sociodemographic data, participants reported their career plans, how well their residency prepared them for various aspects of practice, and their perceptions of PHM fellowship and its effect on their career choices. Results Among the 228 participants, the most planned careers were combined hospital medicine (36.8%, 84/228), combined subspecialty practice (32.5%, 74/228), and primary care (31.1%, 71/228). Residents felt well prepared for patient care and significantly more prepared for inpatient practice than for primary care. Participants rated the potential disadvantages of PHM fellowship as major deterrents and did not view the possible advantages as strong incentives. Among those who had considered a hospital medicine careers, 91.2% (186/203) were less likely to pursue PHM after its certification as a subspecialty. Conclusion Med-peds residents have a wide range of career interests but fellowship has made them less likely to pursue PHM careers. These findings emphasize the importance of addressing the needs of med-peds trained providers as PHM certification pathways and fellowship curricula develop to avoid adverse effects on the workforce.

116 Clinical Impact of Transitioning from a Burn Provider-based to Hospitalist-based Sedation Service

IntroductionBurn patients often experience a tremendous amount of pain and anxiety during dressing changes and other procedures, frequently requiring a moderate sedation (MS) or deep sedation (DS) for successful completion. We previously reported our primarily Nurse Practitioner-based model for procedural sedation but recently transitioned to a primarily hospitalist-based sedation service. We evaluated the clinical and financial impact of this transition.MethodsRetrospective chart review of patients undergoing MS or DS from June 2019 to June 2020 (burn provider-based [BPB]) and August 2020 to August 2021 (hospitalist-based [HB]). Data included demographics, number and types of sedation, provider type, American Society of Anesthesiology Physical Status Classification (ASA score), complications and relative value units (RVU)/anesthesia units generated. Our hospitalist completed a combined Internal Medicine-Pediatrics residency and is credentialed by the institution for procedural sedation.ResultsDuring the BPB sedation timeframe, 263 patients were admitted to the burn center, of which 55 patients (21%) underwent 203 sedations (average: 3.6 sedations/patient). Twenty-one (10%) were DS. The most common medications used for DS were a combination of Midazolam, Ketamine, Fentanyl, Glycopyrrolate and Ondansetron (81%); and for MS, a combination of Fentanyl and Midazolam (77.5%). Ten percent of patients had an ASA of 3 or greater.During the HB sedation timeframe, 203 patients were admitted, of which 73 patients (36%) underwent 353 sedations for an average of 4.8 sedations/patient (74% increase). Ninety-one (26%) were DS (333% increase). Medication combinations were similar as above for DS (90%) and MS (93%). Nineteen percent of patients had an ASA of 3 or greater.Our hospitalist performed 16% of the sedations in the BPB timeframe and 72% in the HB timeframe. In the BPB group there were 4 desaturation events (0.02%) among all sedations, compared to 8 desaturation and 1 hemodynamic change events (0.025%) in the HB group. Total work relative value units (wRVUs) and anesthesia units of service (for the DS) generated were 599.6 and 133 respectively in the BPB group compared to 1104.2 (84% increase) and 784 (489% increase) respectively in the HB group. During the BPB timeframe 40 patients were taken to the OR for dressing changes for a total of 69.3 hours, compared to zero in the HB timeframe.ConclusionsTransitioning from a BPB to HB sedation service resulted in increased sedation numbers and percentage of patients undergoing a sedation, especially DS, as well as increased RVU generation. Sedations were performed in patients with higher ASA scores without a significant increase in adverse events. There was operating room cost and time savings. HB sedation services can be an efficacious and safe model in a burn center.